- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $10,431.19 / $20,928.72
| Facility | | $4,241.22 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,584.12 / $13,894.28 / $24,383.56
| Facility | | $9,584.12 | $13,894.28 | $24,383.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.58 / $2,709.09 / $3,824.15
| Facility | | $1,593.58 | $2,709.09 | $3,824.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $799.14 / $799.14 / $799.14
| Facility | AS | $799.14 | $799.14 | $799.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,870.00 / $3,842.03 / $5,446.70
| Facility | | $2,870.00 | $3,842.03 | $5,446.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |